CDMP-5000 Application Package for Endorsement of Foreign Officer Certificates of Competence

The Commonwealth of Dominica Office of the Maritime Administrator

32 Washington St. Fairhaven, MA 02719 USA Tel: 001-508-992-7170 Fax: 001-508-992-7120 [email protected] www.dominica-registry.com

THE COMMONWEALTH OF DOMINICA Office of the Maritime Administrator APPLICATION FOR DOMINICA ENDORSEMENT OF FOREIGN OFFICER’S STCW CERTIFICATE OF COMPETENCE, DOMINICA MARITIME LICENSE, AND SEAFARER’S ID BOOK

MAKE SURE ALL BOXES ARE COMPLETED. TYPE OR PRINT CLEARLY.

PART I. PERSONAL DESCRIPTION AND INFORMATION: 1. Last Name (Family Name) First Name (Given Name) Middle Initial 2. Date of Birth (dd mm yyyy) 3. Place of Birth (City and Country)

4. Permanent address (street, city and country) 5. Address to which certificate is to be mailed (street, city and country)

Telephone Email Telephone 6. Name and relationship of person to be notified in emergency 7. Citizenship 7a. Passport Number

8. Height 9. Weight 10. Color of Hair Telephone Email 11. Color of eyes 12. Distinguishing Marks 13. Sex Male Female

PART II. REQUESTED LICENSE/CERTIFICATES: Mark all that apply below, by placing an “X” in the proper box. All applicants are required to have a Dominica SID. INITIAL - I am applying for: RENEWAL/UPGRADE: I am applying for: Certificate of Endorsement AND Seafarer’s Identification & Discharge Book Renewal or Upgrade of Certificate of Endorsement and Seafarer’s Identification & Discharge Book Please choose grade/level of certificate desired: Deck Officers Engineering Officers Grade < 500 GT 500<>3000 > 3000 GT Grade < 750kW 750 <> 3000 kW > 3000 kW Master II/3.5 II/2.3 II/2.1 Ch. Engineer N/A III/3.1 III/2.1 Chief Mate N/A II/2.3 II/2.1 2nd Engineer N/A III/3.1 III/2.1 OICNW II/3.3 II/1 (>500 GT) OICEW N/A III/1 III/1 OICNW II/3.4 near coastal Electro-Technical Officer III/6

Note Limitations here: Not for Service on Tankers Motor Other (please specify) ______

GMDSS Certificate of Competence Original Replacement Renewal I am applying for a Certificate of Competence for GMDSS/Radio Officer Certificate - Reg. IV/2

Ship Security Officer Certificate of Proficiency Original Replacement I am applying for a Certificate of Proficiency as Ship Security Officer – Reg. VI/5

(required for all Officers on board vessels over 500 gross tons)

Special Training Certificate of Proficiency Original Replacement I am applying for a Certificate of Proficiency for Training required to serve in certain functions onboard ships: Choose from the below choices: V/1-1.3 – Oil Tanker Personnel Advanced V/1-1.5 – Chemical Tanker Personnel Advanced V/1-2.3 – Liquefied Gas Tanker Personnel Adv. V/2 – Personnel on Passenger Vessels VI/4 – Medical Care Person in Charge VI/6 – Security Awareness Training/Security Training Examination I hereby apply for examination for a Dominica license. Desired Testing Area: Training Record Book I hereby apply for a Training Record Book for upgrade to capacity:

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Applicant Name: ______Name of vessel on which now serving (or will join): ______

PART III. DESCRIPTION OF HIGHEST GRADE FOREIGN CERTIFICATE OF COMPETENCE NOW HELD: Grade of Certificate of Competence Certificate # Date Issued Date Expires Country of Issue

PART IV. SEA SERVICE Submit proof of at least the minimum service required (See Attachment A to this application for specific license requirements) during the last five years or more to establish eligibility for the Certificate of Competence requested. This proof may include copies of your discharge book sea service pages (ensure your Seafarer Book ID# is visible on each page) and/or sea service letters provided by your employer. At minimum, this proof shall include: 1. Propulsion (Steam or Motor) 2. Name of Vessel 3. Deck Officers list Gross Tons/ Engineers list kW Propulsion Power 4. Flag 5. Name of Managing Operator 6. Capacity in which served 7. Period of Service

PART V. APPLICANTS FOR RADIO OPERATORS CERTIFICATE PART VI. APPLICANTS FOR STCW CERTIFICATE OF MUST READ AND SIGN THIS OBLIGATION. COMPETENCE/ENDORSEMENT AT THE MANAGEMENT LEVEL MUST SIGN THIS AFFIDAVIT/ACKNOWLEDGMENT. By affirming my signature below, I acknowledge that I am obliged to ensure and These applicants include Master and Chief Mate applicants for the service on board ships of 500 maintain the secrecy of all telecommunications of which I may gain knowledge in the gross tonnage or more, as well as Chief Engineer and Second Engineer applicants for service on course of my services, and that I am likewise obliged not to reveal the existence or board ships powered by main propulsion machinery of 750 kW propulsion power or more. I contents of any correspondence to anyone other than the addressee. My signature hereby understand that I will become familiar with the national maritime legislation of the further acknowledges that, if I should breach these obligations, my Certificate of Commonwealth of Dominica relevant to the functions to be performed by me for which I have Competence issued pursuant to this application may be suspended and/or revoked. applied to be certificated, and that those regulations are available on the Administration’s website: www.dominica-registry.com .

Signature Signature

Copies of the following identity documents (with name and numbers visible) indicated below are being submitted with this application. Originals are required at time of testing: Seafarer’s Book or Card Passport Foreign Certificate of Competence and Endorsement

PART VII. AFFIDAVIT OF APPLICANT APPLICATION CANNOT BE ISSUED UNLESS APPLICANT SIGNS BELOW I hereby affirm that all information provided by me in this application and its supporting documents and proofs are true and correct to the best of my knowledge and belief; further, that no certificate issued to me heretofore by any Government has ever been revoked or suspended; or, if revoked or suspended, a full explanation of the circumstances is attached hereto and made part of this application.

Date of Application Signature of Applicant

______

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PART VIII. IDENTIFICATION INFORMATION

MARINER APPLICANT FULL NAME : DATE OF BIRTH:

PASSPORT#

Signature: Please use the space below to sign your name clearly, without touching PHOTO any of the box lines. This signature will be transferred to your Seafarer’s ID book. - ORIGINAL COLOR PHOTO - CLEAR RESOLUTION

PLEASE STAY WITHIN THE LINES

Thumbprint: Please use the spaces below for 2 copies each of your left and right thumbprint. Using a traditional blue or black inkpad, roll your thumb from the outer edge over to the right edge in the inkpad and then in the space below, roll from left to right onto the paper to create a clear imprint (repeat the process of inking and transferring for each imprint). We are asking for multiple imprints, so we may select the clearest one for imprinting on your Seafarer’s ID book. LEFT THUMB RIGHT THUMB

Thumbprint 1 Thumbprint 2 Thumbprint 1 Thumbprint 2

EXAMPLES

Unacceptable Unacceptable Acceptable

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PART IX GENERAL INFORMATION AND INSTRUCTIONS

1. READ INSTRUCTIONS CAREFULLY. Enter all required information. Please use computer or print legibly. Failure to properly complete this application or to submit required supporting proofs, etc. will result in rejection of the application or delay its approval. PLEASE DO NOT STAPLE THE APPLICATION OR ITS ATTACHMENTS.

2. WHERE TO APPLY. Applications must be submitted, by mail or in person, to: Dominica Maritime Registry, Inc., 32 Washington Street, Fairhaven, Massachusetts 02719 USA

3. GENERAL INFORMATION (a) This application is subject to the approval of the Maritime Administrator, Commonwealth of Dominica. In the event approval is not granted, all application documents together with the issuance fee (less shipping costs) shall be returned to the applicant at the mailing address indicated. If the application is approved, the issued certificate/identification book will be sent to the mailing address indicated. The ‘certified copy’ of Form CDMP-5000 is to be retained by the seafarer as evidence that the application is being processed. (b) Seafarer’s ID and Discharge Book (SIB): This identification document conforms to the requirements of the International Labor Organization (ILO) Convention No. 185 (Seafarer's Identity Documents Convention, 2003). It is issued to seafarers of Commonwealth of Dominica flag vessels for use when traveling to or from an assigned vessel or pursuant to instructions from the master of such a vessel. Other uses of the book must be in conformity with Commonwealth of Dominica regulations. ILO 185 does not in any way restrict the right of a member nation from preventing any particular individual from entering or remaining in its territory. (c) The SIB and Training Record Books are issued under the authority of Chapter 8 of the International Maritime Act 2000, as amended. The SIB and TRB remain the property of the Maritime Administrator and may be withdrawn at any time. It may not be altered in any way (other than for the purpose of recording sea time or to records completed assessments) nor be allowed to pass into the possession of an unauthorized person. If the TRB becomes filled with entries, requires alteration, becomes damaged, application for a replacement TRB should be made immediately. If the SIB, TRB or Certificate of Competence is stolen, lost, or accidentally destroyed, notification should be given immediately to office of the Maritime Administrator, and an application for a replacement SID/TRB may be made along with an Affidavit of Lost, Stolen or Destroyed Certificate or Document. (Form CDMP-5000 and CDMP-4007)

4. AGE AND CITIZENSHIP REQUIREMENTS. Please refer to Appendix A for age requirements for specific licenses and endorsements. Applicants may be of any nationality and need not be citizens or residents of the Commonwealth of Dominica.

5. TRAINING REQUIREMENTS. Applicants for a Dominica certificate or endorsement must meet the applicable training and sea-time requirements and submit copies of training certificates with their application. Appendix A lists these requirements by STCW regulation number and license, including training required for personnel on certain types of ships.

6. GLOBAL MARITIME DISTRESS AND SAFETY SYSTEM (GMDSS) CERTIFICATES. (a) Restricted Operator - Previous service not required. The candidate must pass the written examination for a certificate as GMDSS Restricted operator or present a foreign certificate in equivalent grade. (b) General Operator (STCW Reg. IV/2.2) - Previous service not required. The candidate must complete an approved course for a certificate as GMDSS General Operator or present a foreign certificate in equivalent grade.

7. SEA SERVICE REQUIREMENTS. Applicants must provide proof of the minimum amount of sea service/marine training required for the grade of certificate for which application is made (see Appendix A for sea service requirements for specific licenses). Applicants for an original, renewal or upgrade Certificate of Competence must show one (1) year’s sea service in the last five (5) years.

8. DOCUMENTS TO BE FILED WITH APPLICATION. The following documents, letter and proofs must be submitted together with this application (See Appendix A for requirements by STCW Regulation) (a) Two (2) color 2.0” x 2.0” (50 mm. x 50 mm.) photographs - facial front view of applicant, passport size, taken within one (1) year preceding application with applicant's signature and name printed on reverse side. Please do not staple. (b) Physical Examination Report (in this package) - The physical examination must be carried out not more than 12 months prior to date of making application. (c) Identity Document - A copy of a valid passport along with a valid seaman's document or certificate of competence from another maritime nation. A copy of these documents must be submitted with the application. Applications for renewal must include a copy of the previously issued documents as proof of identity. Documents shall be provided in English.

9. FEES. Our complete fee schedule is available in Policy Letter 01-14 and is available on our website www.dominica-registry.com . Payment must be made by check, credit card, wire or money order drawn on a U.S. Bank and payable in U.S. dollars to "Dominica Maritime Registry, Inc."

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COMMONWEALTH OF DOMINICA PHYSICAL EXAMINATION REPORT

Part I PERSONAL INFORMATION (This section to be completed by applicant)

Last Name First Name Middle Initial

Date of birth Place of Birth Sex

City Country Male Female Mailing address of applicant Department:

Deck officer Engine officer Deck rating Engine rating Radio officer Other

Food handling

Passport number and country of issue: Routine and emergency duties (if known):

Type of ship: Trade area:

Examinee’s Personal Declaration: (To be completed by the seafarer with the help of medical staff, if requested)

Have you ever had any of the following conditions?:

Condition YES NO Condition YES NO 1. Eye/vision problem 19. Do you smoke, use alcohol or drugs? 2. High blood pressure 20. Operation/surgery 3. Heart/vascular disease 21. Epilepsy/seizures 4. Heart surgery 22. Dizziness/fainting 5. Varicose veins/piles 23. Loss of consciousness 6. Asthma/bronchitis 24. Psychiatric problems 7. Blood disorder 25. Depression 8. Diabetes 26. Attempted suicide 9. Thyroid problem 27. Loss of memory 10. Digestive disorder 28. Balance problem 11. Kidney problem 29. Severe headaches 12. Skin problem 30. Ear (hearing, tinnitus)/nose/throat 13. Allergies problem 14. Infectious/contagious diseases 31. Restricted mobility 15. Hernia 32. Back or joint problem 16. Genital disorder 33. Amputation 17. Pregnancy 34. Fractures/dislocations 18. Sleep problem

If you answered “yes” to any of the above questions, please provide details:

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Additional Questions YES NO 35. Have you ever been signed off sick or repatriated from a ship? 36. Have you ever been hospitalized? 37. Have you ever been declared unfit for sea duty? 38. Has your medical certificate ever been restricted or revoked? 39. Are you aware that you have any medical problems, diseases, or illnesses? 40. Do you feel healthy and fit to perform the duties of your designated position/occupation?

Comments:

Additional Questions YES NO 41. Are you allergic to any medication?

If yes, please list the medications taken, and the purpose(s) and dosage(s):

Attestations

I hereby certify that the personal declaration above is a true statement to the best of my knowledge.

Signature of examinee: ______Date (dd/mm/yyyy):______

Witnessed by (signature): ______Name: ______

I hereby authorize the release of all my previous medical records from any health professionals, health institutions and public authorities to Dr. ______(the approved medical practitioner).

Signature of examinee: ______Date (dd/mm/yyyy):______

Witness by (signature): ______Name: ______

Date and contact details for previous medical examination (if known): ______

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Part II MEDICAL EXAMINATION (This section to be completed by physician)

Sight Use of glasses or contact lenses: YES NO (if yes, specify which type and for what purpose):

Visual Acuity Unaided Aided Right Eye Left Eye Binocular Right Eye Left Eye Binocular Distant Near

Visual Fields

Normal Defective Normal Defective Right Eye Left Eye

Colour Vision

Not tested Normal Doubtful Defective

Hearing Pure tone and audiometry (threshold values in dB) 500 HZ 1000 HZ 2000 HZ 3000 HZ Right Ear Left Ear

Speech and Whisper Test (metres)

Normal Whisper Normal Whisper Right Ear Left Ear

Clinical Findings Height: (cm) Weight: (kg) Pulse rate: /(min.) Rhythm: Blood pressure Systolic: (mmHg) Diastolic: (mm/Hg) Urinalysis: Glucose: Protein: Blood:

Normal Abnormal Normal Abnormal Head Skin Sinuses, nose, throat Varicose veins Mouth/teeth Vascular (inc. pedal pulses) Ears (general) Abdomen and viscera Tympanic membrane Hernia Eyes Anus (not rectal exam) Ophthalmoscopy G-U system Pupils Upper and lower extremities Eye movement Spine (C/S, T/S and L/S) Lungs and chest Neurological (full/brief) Breast examination Psychiatric Heart General appearance

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Chest X-ray

Not performed Performed on (dd/mm/yyyy):

Results:

Other Diagnostic Test(s) and Result(s):

Test: Result:

Medical practitioner’s comments and assessment of fitness, with reasons for any limitations:

Assessment of Fitness for Service at Sea

On the basis of the examinee’s personal declaration, my clinical examination and the diagnostic test results recorded above, I declare the examinee medically:

Fit for duty Not fit for duty

Deck Service Engine Service Catering Service Other Service Fit Unfit

With restrictions Without restrictions Visual aid required Visual aid not required

Describe restrictions (e.g., specific position, type of ship, trade area)

Physician’s Signature and Stamp

Signature of medical practitioner:

Medical practitioner information (name, license number, address):

PHYSICIAN’S STAMP HERE

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MEDICAL REQUIREMENTS

All applicants for an officer certificate, Seafarer’s Identification and Training Record Book or certification of special qualification shall be required to have a physical examination reported on this Medical Form completed by a certificated physician. The completed medical form must accompany the application for officer certificate, application for seafarer’s identity document, or application for certification of special qualifications. This physical examination must be carried out not more than 12 months prior to the date of making application for an officer certificate, certification of special qualifications, or a seafarer’s book. Such proof of examination must reestablish that the applicant is in satisfactory physical condition for the specific duty assignment undertaken and is generally in possession of all body faculties necessary in fulfilling the requirements of the seafaring profession. In addition, the following minimum requirements shall apply:

1) All applicants must have hearing unimpaired for normal sounds and be capable of hearing a whispered voice in the better ear at 15 feet and in the poorer ear at 5 feet. 2) Deck officer applicants must have (either with or without corrective lenses) at least 20/20 vision in one eye and at least 20/40 in the other. If the applicant uses corrective lenses, he must have vision without corrective lenses of at least 20/160 in both eyes. Deck officer applicants must also have normal color perception and be capable of distinguishing the colors red, green, blue and yellow. 3) Engineer and radio officer applicants must have (whether with or without corrective lenses) at least 20/30 vision in one eye and at least 20/50 in the other. If the applicant wears glasses, he must have vision without glasses of at least 20/200 in both eyes. Engineer and radio officer applicants must also be able to perceive the colors red, yellow and green. 4) An applicant’s blood pressure must fall within an average range, taking age into consideration. 5) Applicants afflicted with any of the following diseases or conditions may be disqualified: a) Epilepsy; s) Obesity, incapacitating function; jj) Recurrent appendicitis; b) Insanity; t) Thyroid disease; kk) Cholelithiasis, cholecystitis, c) Senility; u) Diseases of the blood or blood cholangitis; d) Psychosis; forming organs; ll) Liver cirrhosis; e) Psychoneurosis; v) Meniere’s diseases; mm) Pancreatitis, recurrent; f) Dementia; w) Post-concussion syndrome; nn) Intestinal stoma; g) Personality disorder; x) Heart disease; oo) Perianal pathology; h) Alcoholism; y) Hypertension; pp) Renal failure; i) Tuberculosis; z) Arterial disease; qq) Urinary tract obstruction; j) Acute venereal disease or neurosyphilis; aa) Cerebrovascular disease; rr) Prostatism; k) AIDS; bb) Diseases of veins; ss) Removal of one kidney; l) The use of narcotics; cc) Bronchial asthma tt) Renal transplantation; m) Hepatitis; dd) Pulmonary fibrosis; uu) Hydrocoele, large, symptomatic; n) Malaria ee) Gross deformity of the chest wall; vv) Osteoarthritis; o) Sexually transmitted diseases; ff) Pneumothorax; ww) Recurrent dislocation of major joint; p) Adrenal insufficiency, uncontrolled; gg) Tumors; xx) Infection or inflammatory ear q) Diabetes mellitus, all cases requiring hh) Peptic ulcers; conditions; insulin; ii) History of gastro-intestinal yy) Sleep disorders; and r) Immunosuppressive therapy; bleeding/perforation; zz) Severe speech impediment.

6) Deck/Navigational officer applicants and Radio officer applicants must have speech which is unimpaired for normal voice communication. 7) Applicants for RFPNW, Ordinary Seaman, Able Seafarer Deck, Cook , Deck Cadet or any deck rating position must meet the physical requirements for a deck/navigational officer’s certificate. 8) Applicants for RFPEW, Able Seafarer Engine, Electro Technical Rating, Tankerman, Engine Cadet or any other engineering rating must meet the physical requirements for an engineer officer’s certificate.

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ATTACHMENT A: REQUIREMENTS FOR DOMINICA OFFICER CERTIFICATES OF COMPETENCE & ENDORSEMENT AND SPECIAL QUALIFICATIONS

DECK LICENSES

REG: II/1 Officer in charge of a navigational watch, on ships of 500 gross tonnage or more (Oceans)

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 18 years □ ARPA o Submit copy of Passport □ GMDSS* □ Sea service - 3 years sea-service or 1 year sea service □ Basic Safety Training as part of approved training program □ Bridge Resource Management o Submit Sea Service Letters or copies of □ Celestial Navigation discharge papers □ Advanced Firefighting o 1/3 of Sea time must be completed on ships of □ ECDIS respective tonnage/propulsion power according to □ Radar application □ OICNW > 500 GT Course □ Min. 6 months supervised bridge watch duties during □ Proficiency in survival craft sea time □ Proficiency in medical first aid+ o Submit letter from Company/Vessel □ Proficiency in fast rescue boats □ Dominica Application and Physical Exam □ Ship Security Officer Training Ensure application is complete o o Include copy(s) of any previously or currently held * GMDSS training is required only for personnel serving on ships with the respective equipment installed. licenses or Certificates of Competency + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.1 Master on ships of 3000 gross tonnage or more (Oceans)

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 21 years □ ARPA o Submit copy of passport □ GMDSS* □ Sea service - 36 months as OICNW or 24 months as □ Basic Safety Training OICNW with 12 months service as Chief Mate □ Bridge Resource Management o Submit Sea Service Letters or copies of □ Celestial Navigation (for oceans endorsement) discharge papers □ Advanced Firefighting □ 1/3 of Sea time must be completed on ships of □ ECDIS respective tonnage/propulsion power according □ Radar to application □ Master/Mate greater than 500 GT □ Proficiency in survival craft □ Dominica Application and Physical Exam □ Proficiency in medical first aid+ o Ensure application is complete □ Proficiency in fast rescue boats o Include copy(s) of any previously or currently □ Ship Security Officer Training held licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.1 Master on ships of 3000 gross tonnage or more, near coastal

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 21 years □ ARPA o Submit copy of passport □ GMDSS* □ Sea service - 36 months as OICNW or 24 months as □ Basic Safety Training OICNW with 12 months service as Chief Mate □ Bridge Resource Management o Submit Sea Service Letters or copies of □ Advanced Firefighting discharge papers □ ECDIS □ 1/3 of Sea time must be completed on ships of □ Radar respective tonnage/propulsion power according to □ Master/Mate greater than 500 GT application □ Proficiency in survival craft □ Proficiency in medical first aid+ □ Dominica Application and Physical Exam □ Proficiency in fast rescue boats o Ensure application is complete □ Ship Security Officer Training o Include copy(s) of any previously or currently held licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.1 Chief mate on ships of 3000 gross tonnage or more (Oceans)

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 19 years □ ARPA o Submit copy of passport □ GMDSS* □ Basic Safety Training □ Sea service - 12 months as OICNW □ Bridge Resource Management o Submit Sea Service Letters or copies of □ Celestial Navigation (for oceans endorsement) discharge papers □ Advanced Firefighting o 1/3 of Sea time must be completed on ships of □ ECDIS respective tonnage/propulsion power according to □ Radar application □ Master/Mate greater than 500 GT □ Proficiency in survival craft □ Dominica Application and Physical Exam □ Proficiency in medical first aid+ o Ensure application is complete □ Proficiency in fast rescue boats o Include copy(s) of any previously or currently held □ Ship Security Officer Training licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.1 Chief mate on ships of 3000 gross tonnage or more, near coastal

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 19 years □ ARPA o Submit copy of passport □ GMDSS* □ Basic Safety Training □ Sea service - 12 months as OICNW □ Bridge Resource Management o Submit Sea Service Letters or copies of □ Advanced Firefighting discharge papers □ ECDIS o 1/3 of Sea time must be completed on ships of □ Radar respective tonnage/propulsion power according to □ Master/Mate greater than 500 GT application □ Proficiency in survival craft □ Proficiency in medical first aid+ □ Dominica Application and Physical Exam □ Proficiency in fast rescue boats o Ensure application is complete □ Ship Security Officer Training o Include copy(s) of any previously or currently held licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.3 Master on ships of between 500 & 3000 gross tonnage (Oceans)

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 21 years □ ARPA o Submit copy of passport □ GMDSS* □ Basic Safety Training □ Sea service - 36 months as OICNW or 24 months as □ Bridge Resource Management OICNW with 12 months service as Chief Mate □ Celestial Navigation (for oceans endorsement) o Submit Sea Service Letters or copies of □ Advanced Firefighting discharge papers □ ECDIS o 1/3 of Sea time must be completed on ships of □ Radar respective tonnage/propulsion power according to □ Master/Mate greater than 500 GT application □ Proficiency in survival craft □ Proficiency in medical first aid+ □ Dominica Application and Physical Exam □ Proficiency in fast rescue boats o Ensure application is complete □ Ship Security Officer Training o Include copy(s) of any previously or currently held licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.3 Master on ships of between 500 & 3000 gross tonnage, near coastal

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 21 years □ ARPA o Submit copy of passport □ GMDSS* □ Basic Safety Training □ Sea service - 36 months as OICNW or 24 months as □ Bridge Resource Management OICNW with 12 months service as Chief Mate □ Advanced Firefighting o Submit Sea Service Letters or copies of □ ECDIS discharge papers □ Radar o 1/3 of Sea time must be completed on ships of □ Master/Mate greater than 500 GT respective tonnage/propulsion power according to □ Proficiency in survival craft application □ Proficiency in medical first aid+ □ Proficiency in fast rescue boats □ Dominica Application and Physical Exam □ Ship Security Officer Training o Ensure application is complete * GMDSS training is required only for personnel serving on ships with the respective equipment installed. o Include copy(s) of any previously or currently held licenses or Certificates of Competency + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.3 Chief mate on ships of between 500 & 3000 gross tonnage (Oceans)

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 18 years □ ARPA o Submit copy of passport □ GMDSS* □ Basic Safety Training □ Sea service - meet requirements of II/1 - OICNW □ Bridge Resource Management o Submit Sea Service Letters or copies of □ Celestial Navigation (for oceans endorsement) discharge papers □ Advanced Firefighting o 1/3 of Sea time must be completed on ships of □ ECDIS respective tonnage/propulsion power according to □ Radar application □ Master/Mate greater than 500 GT □ Proficiency in survival craft □ Dominica Application and Physical Exam □ Proficiency in medical first aid+ o Ensure application is complete □ Proficiency in fast rescue boats o Include copy(s) of any previously or currently held □ Ship Security Officer Training licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/2.3 Chief mate on ships of between 500 & 3000 gross tonnage, near coastal

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 18 years □ ARPA o Submit copy of passport □ GMDSS* □ Basic Safety Training □ Sea service - meet requirements of II/1 - OICNW □ Bridge Resource Management o Submit Sea Service Letters or copies of □ Advanced Firefighting discharge papers □ ECDIS o 1/3 of Sea time must be completed on ships of □ Radar respective tonnage/propulsion power according to □ Master/Mate greater than 500 GT application □ Proficiency in survival craft □ Proficiency in medical first aid+ □ Dominica Application and Physical Exam □ Proficiency in fast rescue boats o Ensure application is complete □ Ship Security Officer Training o Include copy(s) of any previously or currently held licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

REG: II/3.1 Officer in charge of a navigational watch on ships of less than 500 gross tonnage (Oceans)

See Regulation II/1 for Officer in Charge of a Navigational Watch on ships of 500 gross tonnage or more

REG: II/3.2 Master on ships of less than 500 gross tonnage (Oceans)

See Regulation II/2.3 for Master on ships of between 500 & 3000 gross tonnage

REG: II/3.3 Officer in charge of a navigational watch on ships of less than 500 gross tonnage, near coastal

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 18 years □ ARPA o Submit copy of passport □ GMDSS* □ Basic Safety Training □ Sea service - Must hold certificate for OICNW > 500 gt: □ Bridge Resource Management o 3 years sea-service or 1 year sea service as part □ Advanced Firefighting of approved training program □ ECDIS o Submit Sea Service Letters or copies of □ Radar discharge papers □ OICNW > 500 GT Course o 1/3 of Sea time must be completed on ships of □ Proficiency in survival craft respective tonnage/propulsion power according to □ Proficiency in medical first aid+ application □ Proficiency in fast rescue boats

□ Min. 6 months supervised bridge watch duties during sea time * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for o Submit letter from Company/Vessel Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats □ Dominica Application and Physical Exam o Ensure application is complete o Include copy(s) of any previously or currently held licenses or Certificates of Competency

REG: II/3.5 Masters on ships of less than 500 gross tonnage, near coastal

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 20 years □ ARPA o Submit copy of Passport □ GMDSS* □ Sea Service –12 months as OICNW □ Basic Safety Training o Submit Sea Service Letters or copies of □ Bridge Resource Management discharge papers □ Advanced Firefighting o 1/3 of Sea time must be completed on ships of □ ECDIS respective tonnage/propulsion power according to □ Radar application □ Master/Mate less than 500 GT □ Dominica Application and Physical Exam □ Proficiency in survival craft o Ensure application is complete □ Proficiency in medical first aid+ o Include copy(s) of any previously or currently held □ Proficiency in fast rescue boats licenses or Certificates of Competency * GMDSS training is required only for personnel serving on ships with the respective equipment installed. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency in Fast Rescue Boats training is required only for personnel serving on ships with Fast Rescue Boats

ENGINE LICENSES

REG: III/1 Officer in charge of an engineering watch in a manned engine-room or Designated duty engineer in a periodically unmanned engine-room

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 18 years □ Basic Safety Training o Submit copy of Passport □ Advanced Firefighting □ Sea Service □ OICEW Course o 6 months sea-going plus 30 months training □ Proficiency in survival craft and education with completed TRB for III/1 sea □ Proficiency in medical first aid+ time □ Ship Security Officer Training o Submit letter from Company/Vessel or copies of pages from discharge book(s) □ Dominica Application and Physical Exam o Ensure application is complete + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. o Include copy(s) of any previously or currently held licenses or Certificates of Competency

REG: III/2 Chief engineer officer on ships powered by main propulsion machinery of 3,000 kW propulsion power or more

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 21 years □ Basic Safety Training o Submit copy of passport □ Advanced Firefighting □ Meet Requirements for OICEW □ Chief Engineer 3000 kW Course o 6 months sea-going plus 30 months training □ Proficiency in survival craft and education with completed TRB for III/1 sea □ Proficiency in medical first aid+ time □ Ship Security Officer Training □ Sea service o 36 months sea service or 24 months with at least 12 months as a 2nd Engineer on vessel of 3000 kW propulsion power or more □ Dominica Application and Physical Exam + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. o Ensure application is complete

o Include copy(s) of any previously or currently held licenses or Certificates of Competency

REG: III/2 Second engineer officer on ships powered by main propulsion machinery of 3,000 kW propulsion power or more

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 19 years □ Basic Safety Training o Submit copy of passport □ Advanced Firefighting nd □ Meet Requirements for OICEW □ 2 Engineer 3000 kW Course o 6 months sea-going plus 30 months training □ Proficiency in survival craft and education with completed TRB for III/1 sea □ Proficiency in medical first aid+ time □ Ship Security Officer Training □ Sea service o 12 months sea service as Assistant Engineer or Engineer Officer on vessel of 3,000 kW propulsion power or more o Submit letter from Company/Vessel or copies + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for of pages from discharge book(s) Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. □ Dominica Application and Physical Exam o Ensure application is complete o Include copy(s) of any previously or currently held licenses or Certificates of Competency

REG: III/3 Chief engineer officer on ships powered by main propulsion machinery between 750 & 3000 kW

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 20 years □ Basic Safety Training o Submit copy of passport □ Advanced Firefighting □ Meet Requirements for OICEW □ Chief Engineer between 750&3000 kW Course o 6 months sea-going plus 30 months training □ Proficiency in survival craft and education with completed TRB for III/1 □ Proficiency in medical first aid+ sea time □ Ship Security Officer Training □ Sea service o 24 months sea service with at least 12 months as a engineering officer ona vessel between 750 & 3000 kW propulsion power o Submit letter from Company/Vessel or copies of pages from discharge book(s) + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. □ Dominica Application and Physical Exam

o Ensure application is complete o Include copy(s) of any previously or currently held licenses or Certificates of Competency

REG: III/3 Second engineer officer on ships powered by main propulsion machinery between 750 & 3000 kW

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 19 years □ Basic Safety Training o Submit copy of passport □ Advanced Firefighting nd □ Meet Requirements for OICEW □ 2 Engineer between 750&3000 kW Course o 6 months sea-going plus 30 months training □ Proficiency in survival craft and education with completed TRB for III/1 □ Proficiency in medical first aid+ sea time □ Ship Security Officer Training □ Sea service nd o 12 months sea service as Assistant Engineer Note: Qualified 2 Engineer officers of 3,000 kW or more may serve as chief engineer on vessels less or Engineer Officer on vessel between 750 & than 3,000 kW, provided that not less than 12 months of sea service was served as an engineer officer 3000 kW propulsion power in a position of responsibility and certificate is so endorsed □ Dominica Application and Physical Exam o Ensure application is complete + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Include copy(s) of any previously or currently Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. o held licenses or Certificates of Competency

REG: III/6 Electro-technical officer

General Requirements Training Requirements (Submit copies of training certificates) □ Age – 18 years □ Safety Familiarization Training o Submit copy of Passport □ Advanced Firefighting □ Sea Service: □ Basic Safety Training o 12 months combined workshop and skills □ Electro-Technical Officers Course training and at minimum 6 months approved □ Proficiency in survival craft sea service with completion of the Training □ Proficiency in medical first aid+ Record Book OR □ Security Awareness Training o 36 months of combined workshop and skills □ Security Training for Seafarers with Designated Security Duties (if applicable) training and approved seagoing service of which not less than 30 months is in the engine department; o 1/3 of sea service shall be on vessels of 750 kW or more propulsion power. + Medical First Aid Proficiency course required for those designated to provide medical care on board ship. Proficiency for Persons in Charge of Medical Care required for those designated to take charge of medical care on board ship. □ Completed approved education and training meeting competences of A-III/6 of STCW Code;

o Approved training course

□ Meet the standards of competence in A-VI/1, Par. 2; Section A-VI/2 Par. 1-4; Section A-VI/3, Par. 1-4; and Section A-VI/4, par. 1-3 of the STCW Code o Approved training courses □ Dominica Application and Physical Exam o Ensure application is complete o Include copy(s) of any previously or currently held licenses or Certificates of Competency

SPECIAL QUALIFICATIONS

REG: V/1-1.3 Masters, Chief Engineers, Chief Mates, 2nd Engineer and persons with immediate Responsibility on Oil Tankers